Clostridium difficile infection among hospitalized HIV-infected individuals: epidemiology and risk factors: results from a case-control study (2002-2013)

BMC Infectious Diseases

Research Article

Maria Serena Gallone¹  Esther García-Almodóvar²  Alexander W Friedrich³  Fabrizio Taglietti⁴  Vincenzo Galati⁴  Nicola Petrosillo⁴  Simone Topino⁴  Silvia D’Arezzo⁴  Stefano Di Bella⁴  Emma Johnson⁵ 

[1] Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy;Department of Internal Medicine, Manacor Hospital, Palma of Majorca, Spain;Department of Medical Microbiology and Infection Control, University Medical Centre, Groeningen, The Netherlands;National Institute for Infectious Diseases “L. Spallanzani”, Via Portuense 292, 00149, Rome, Italy;University of Sheffield, Sheffield, UK;

关键词: Clostridium difficile;    HIV;    AIDS;    Case-control;    Risk factors;    Albumin;    Gammaglobulins;   

DOI  :  10.1186/s12879-015-0932-x

 received in 2015-01-27, accepted in 2015-04-15,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundHIV infection is a risk factor for Clostridium difficile infection (CDI) yet the immune deficiency predisposing to CDI is not well understood, despite an increasing incidence of CDI among such individuals. We aimed to estimate the incidence and to evaluate the risk factors of CDI among an HIV cohort in Italy.MethodsWe conducted a retrospective case-control (1:2) study. Clinical records of HIV inpatients admitted to the National Institute for Infectious Disease “L. Spallanzani”, Rome, were reviewed (2002-2013). Cases: HIV inpatients with HO-HCFA CDI, and controls: HIV inpatients without CDI, were matched by gender and age. Logistic regression was used to identify risk factors associated with CDI.ResultsWe found 79 CDI episodes (5.1 per 1000 HIV hospital admissions, 3.4 per 10000 HIV patient-days). The mean age of cases was 46 years. At univariate analysis factors associated with CDI included: antimycobacterial drug exposure, treatment for Pneumocystis pneumonia, acid suppressant exposure, previous hospitalization, antibiotic exposure, low CD4 cell count, high Charlson score, low creatinine, low albumin and low gammaglobulin level. Using multivariate analysis, lower gammaglobulin level and low serum albumin at admission were independently associated with CDI among HIV-infected patients.ConclusionsLow gammaglobulin and low albumin levels at admission are associated with an increased risk of developing CDI. A deficiency in humoral immunity appears to play a major role in the development of CDI. The potential protective role of albumin warrants further investigation.

【 授权许可】

CC BY   
© Di Bella et al.; licensee BioMed Central. 2015